Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA; Center for Outcomes Research in Liver Diseases, Washington, DC.
Hepatology. 2015 May;61(5):1471-8. doi: 10.1002/hep.27757. Epub 2015 Mar 23.
Patients with chronic hepatitis C (CHC) exhibit reduced work productivity owing to their disease. Historically, most regimens indicated for CHC genotype 1 (GT1) patients were administered with pegylated interferon (Peg-IFN) and/or ribavirin (RBV), which further compromised work productivity during treatment. The aim of this study was to model the impact of LDV/SOF (ledipasvir/sofosbuvir), the first Peg-IFN- and RBV-free regimen for CHC GT1 patients, on work productivity from an economic perspective, compared to receiving no treatment. The WPAI-SHP (Work Productivity and Activity Index-Specific Health Problem) questionnaire was administered to patients across the ION clinical trials (N = 1,923 U.S. patients). Before initiation of treatment, patients with CHC GT1 in the ION trials exhibited absenteeism and presenteeism impairments of 2.57% and 7.58%, respectively. Patients with cirrhosis exhibited greater work productivity impairment than patients without cirrhosis. In total, 93.21% of U.S. patients in the ION trials achieved SVR; these patients exhibited absenteeism and presenteeism impairments of 2.62% (P = 0.76, when compared to baseline) and 3.53% (P < 0.0001), respectively. Monetizing these data to the entire U.S. population, our model projects an annual societal cost of $7.1 billion owing to productivity loss in untreated GT1 CHC patients. Our model projects that, when compared to no treatment, treating all CHC GT1 patients with a regimen with very high viral eradication rates (LDV/SOF) would translate to annual productivity loss savings of $2.7 billion over a 1-year time horizon.
Patients with untreated HCV impose a substantial societal burden owing to reduced work productivity. As a result of improvements in work productivity, treatment of CHC GT1 patients with LDV/SOF-based regimens is likely to result in significant cost savings from a societal perspective, relative to no treatment.
本研究旨在从经济角度，通过模型模拟 LDV/SOF（来迪派韦索磷布韦）对慢性丙型肝炎病毒（HCV）基因型 1（GT1）患者工作生产力的影响，该药物为首个无聚乙二醇干扰素（Peg-IFN）和/或利巴韦林（RBV）的 HCV GT1 患者治疗方案，与不治疗进行比较。方法：通过 ION 临床试验（N = 1923 名美国患者）向患者发放 WPAI-SHP（工作生产力和活动指数-特定健康问题）调查问卷。在开始治疗前，ION 试验中 GT1 型 CHC 患者的缺勤率和现患率分别为 2.57%和 7.58%。有肝硬化的患者比没有肝硬化的患者工作生产力受损更严重。总的来说，ION 试验中 93.21%的美国患者达到 SVR；这些患者的缺勤率和现患率分别为 2.62%（与基线相比，P = 0.76）和 3.53%（P < 0.0001）。将这些数据货币化到整个美国人群，我们的模型预测由于未治疗的 GT1 CHC 患者生产力下降，每年会造成 71 亿美元的社会成本。我们的模型预测，与不治疗相比，在 1 年的时间内，用非常高的病毒清除率（LDV/SOF）的方案治疗所有 GT1 CHC 患者，将每年节省 27 亿美元的生产力损失。结论：未治疗的 HCV 患者由于工作生产力下降，给社会带来了巨大的负担。由于工作生产力的提高，从社会角度来看，用 LDV/SOF 为基础的方案治疗 GT1 CHC 患者，与不治疗相比，可能会带来显著的成本节约。
